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Thiols, as a class of organic compounds containing sulfhydryl, play important roles in antioxidant, cytoprotective and signaling activities. This study aimed to investigate thiol/disulfide metabolite homeostasis in children with diabetic ketoacidosis (DKA) and their correlation with disease severity and renal impairment. Children with type 1 diabetes mellitus complicated with ketoacidosis from June 2022 to December 2024 were selected for this study. The metabolite levels of thiols and disulfides were measured by collecting blood samples from the children and testing them using a highly automated spectrophotometric assay. Clinical data, including blood glucose, blood ketones, blood gas analysis, and renal function indicators, were collected from the children to assess the severity of the disease and renal impairment. Seventy-two children with DKA (19 mild, 25 moderate, and 28 severe cases), were included. Native thiols were elevated with disease exacerbation, while total thiols and disulfides did not change significantly. Homeostatic index 1 and index 3 differed among the three groups. Reduced renal function was observed in 34 children with DKA, who also had decreased natural thiols, total thiol, and homeostatic index 3. Elevated native thiols were protective factors for disease exacerbation (OR 0.980, 95% CI 0.960-1.000) and renal function decline (OR 0.970, 95% CI 0.950-0.990) in children with DKA. Thiol/disulfide metabolite homeostasis in children with DKA is strongly associated with disease severity and renal impairment. Reduced native thiols are associated with more severe DKA and renal impairment.